Evergreen leaves health insurance exchange

Evergreen Health is no longer allowed to sell insurance on Maryland’s individual health insurance market as a result of the insurer’s "financially hazardous condition," state Insurance Commissioner Al Redmer said in an administrative order Thursday.

Three investors had planned to transform the former insurance co-op into a for-profit company. The deal fell apart Wednesday night because of concerns over Evergreen’s financial health.

“The Maryland Insurance Administration took all possible steps to keep Evergreen in the market,” Redmer said in a statement. “Issuing this order is a difficult decision that had to be made in order to protect Evergreen consumers.”

The nonprofit model tied insurance to primary care offices in a way that boosted members’ health, but was financially unsustainable, said CEO Peter Beilenson.

“We were hit by an extremely bizarre formula called ‘risk adjustment’ that required us amazingly to pay out 28 percent of our premiums to our biggest competitor, which obviously put us at a financially significant disadvantage,” he said.

He urged current Evergreen members to continue paying their premiums to maintain their coverage through the end of their plan years. The Insurance Administration will make the final call on what comes next for the company.

With Evergreen gone, Carefirst and Kaiser will be the only insurers on the individual exchange when open enrollment begins Nov. 1.

As Congress debates cutting access to Planned Parenthood for Medicaid recipients, Maryland’s legislative leaders are pushing a plan to replace the lost funding, which they estimate would be about $2.7 million a year.

Several dozen people defended Medicaid and the Affordable Care Act Monday night at a town hall at the Greater Baltimore Urban League. Maryland congressmen Elijah Cummings and John Sarbanes, both Democrats, listened as person after person shared personal health stories.

Mind the gap. When the 2015 open enrollment period begins on Nov. 15 for plans sold on the individual market, consumers would be wise to act promptly to avoid a gap in coverage.

Failing to do so could leave you exposed to unexpected medical bills. (Uh-oh, appendicitis!) And you could also be hit with a penalty for not having health insurance that kicks in if you go without coverage for three months or more during the year.